Letter to Obama: Change I.T. Strategy

C. Peter Waegemann, CEO of the Medical Records Institute, has sent a letter to President-elect Obama suggesting new national strategies to promote health information technology. Boston-based MRI is an advocacy organization and also sponsors the annual TEPR conference. What follows is the text of the letter, dated Nov. 11:
Dear Mr. President-elect:
For over 25 years, Medical Records Institute has been an internationally recognized leader in promoting Electronic Medical Record (EMR) systems and Electronic Health Record (EHR) systems. Given that less than 25 percent of physicians have adopted such systems, we applaud you and other political leaders from both sides of the aisle for recognizing that the acceleration of EMR implementations should and will be an important priority.

Your new Administration has the capacity and opportunity to correct the mistakes of the past and to create a new strategy for health information technology. EMRs are important tools to guide clinicians to computer-based and computer-guided care. They will increase the quality of care, reduce medical errors, bring potential savings, and make our healthcare system more efficient. However, they alone should not be the goal of health informatics.

A new start is needed that corrects the well-intentioned, but misguided strategies of the Office of the National Coordinator (ONC) and its affiliates that have contributed to slowing the transition to electronically supported healthcare. For example, an important and beneficial shift in direction is needed to move the industry from outdated EDI and messaging standards to XML and web-based standards that are common throughout most other industries.

First, we urge you and your team to recognize the following:

* Mandating EMRs based on penalties would create more unwarranted problems on the physician community that already has difficulties identifying and realizing the return on investment in time and financial terms regarding EMRs.

* Top-down strategies that are not carefully coordinated with the medical community will fail in the same way as such projects have in other countries, notably the United Kingdom.
Instead, the new Administration has a great opportunity to orchestrate a consensus on some of the most important issues that are directly linked to EMR implementation, by:

* Working with all stakeholders to create continuity of care: This was the original goal of EMR visionaries some 30 years ago. Technologies are ready today for ensuring that all clinicians have all relevant patient information when they provide care to patients. The leadership of your Administration can make this a reality and thus save substantial monies by reducing duplicative tests and efforts, improving the quality of care, and reducing medical errors.

* Using the Federal Government's leadership to involve all stakeholders in reforming the financial healthcare processes into 21st century approaches that include charge capture from EMR documentation, real-time transactions, and automated claim adjudication.

* Creating the necessary infrastructure for electronically supported care by reducing or eliminating barriers for inter-State care and Internet-based e-care. For example, clinicians should be reimbursed for email communications with patients as well as for other electronically delivered healthcare services.

* Coordinating efforts with payers and providers to shift our healthcare system to one that pays for keeping people healthier rather than only for treating the sick. This is a major paradigm shift your Administration could orchestrate.

New strategies are essential to improve healthcare. Questions to be answered include: How can mistakes of the past be avoided? Why did the healthcare field not make more progress toward computerization? Which standards, State and Federal legislation, and industry certification are holding us back?

The nation is waiting for a bold vision to a new approach to healthcare itself and its important information technology components. Again, the healthcare community does not need a mandate but rather an orchestrated approach. We believe your Administration has the capacity and desire to do just that, and we stand ready to assist.

Peter Wagonen, is the CEO of the Medical Records Institute, a Boston-based organization involved in applied research and functioning as an educational clearinghouse. He is considered an international leader in medical informatics with a special interest in electronic patient record systems, standards, networking, telemedicine, and the creation of the national information infrastructure. Contact him at peter@medrecinst.com or visit www.medrecinst.com